Venflon, Friend or Foe?Venflon, Friend or Foe?

Saranaz JamdarSaranaz Jamdar Consultant MicrobiologistConsultant Microbiologist

Venflon or Cannula?Venflon or Cannula? Venflon is a brand name not the Venflon is a brand name not the

devicedevice Manufactured by BDManufactured by BD Peripheral vascular catheter (PVC) or Peripheral vascular catheter (PVC) or

cannulacannula In Forth Valley we currently use In Forth Valley we currently use

B/BraunB/Braun

History of IV InfusionHistory of IV Infusion William Harvey, explained blood William Harvey, explained blood

circulation, 1628circulation, 1628 11stst book on application book on application of intravenousof intravenous infusion in humans, infusion in humans, Major 1664 andMajor 1664 and Elsholtz 1667Elsholtz 1667

History of IV InfusionHistory of IV Infusion

11stst proper IV infusion proper IV infusionDr Thomas LattaDr Thomas Latta22ndnd Cholera Cholera pandemic, affectingpandemic, affecting UK, 1832UK, 1832

Traditional IV Infusion NeedlesTraditional IV Infusion Needles

First IV CannulaFirst IV Cannula

11STST modern cannula, “Branula” modern cannula, “Branula”Dr B Braun, Germany 1962Dr B Braun, Germany 1962

Later ModelsLater Models

Modern modelsModern models

ComplicationsComplications Extravasation Extravasation

ComplicationsComplications Haemorrhage/bleedingHaemorrhage/bleeding

ComplicationsComplications InfectionInfection

− locallocal− SystemicSystemic

Staph aureusStaph aureus (MSSA, MRSA) (MSSA, MRSA) Streptococcus spp.Streptococcus spp. Gram negative bacteriaGram negative bacteria Candida spp.Candida spp.

Staphylococcus aureusStaphylococcus aureus

Streptococcus spp.Streptococcus spp.

Gram Negative Bacteria Gram Negative Bacteria EnterobacteraciaeEnterobacteraciae Pseudomonas sp.Pseudomonas sp. Environmental organismsEnvironmental organisms

Candida spp.Candida spp.

Some ExamplesSome Examples

Some MoreSome More

Infection in Forth ValleyInfection in Forth ValleyLocal infection (5 so far this week!)Local infection (5 so far this week!)Bacteraemia (1 this week!)Bacteraemia (1 this week!)Secondary site of infectionSecondary site of infection (ask me in a few months) (ask me in a few months)

– AbscessAbscess– Osteomyelitis/septic arthritisOsteomyelitis/septic arthritis– EndocarditisEndocarditis– Overwhelming sepsisOverwhelming sepsis– DeathDeath

Staphylococcus aureus, RETURNS

BEWARE

Situation in Forth ValleySituation in Forth Valley

Origin of SAB

0

2

4

6

8

10

12

14

Apr-10

May-10

Jun-10

Jul-10

Aug-10

Sep-10

Oct-10

SAB

Num

bers

Other

Unknow n

Skin & Soft Tissue

Device associated

Some Real Cases in FVSome Real Cases in FV

Case 1Case 1 Patient admitted with D+VPatient admitted with D+V IV fluidsIV fluids IV cannula site inflamedIV cannula site inflamed Grew Grew Staph aureus Staph aureus (MSSA)(MSSA) Clinical deterioration despite Clinical deterioration despite

antibiotic therapyantibiotic therapy

Case 1Case 1 Theatre for debridement and Theatre for debridement and

drainage of abscessdrainage of abscess Grew S.aureus (MSSA) againGrew S.aureus (MSSA) again

Some Real Cases in FVSome Real Cases in FV

Case 2Case 2 NeonateNeonate IV cannula on legIV cannula on leg Local infection and spread to jointLocal infection and spread to joint Septic arthritis of kneeSeptic arthritis of knee Bacteraemia, Bacteraemia, Staph aureusStaph aureus

Case 2Case 2

Some Real Cases in FVSome Real Cases in FV

Case 3Case 3IV cannula site infection, IV cannula site infection, another hospitalanother hospitalBacteraemia, Bacteraemia, another hospitalanother hospitalSecondary site involvement, silentSecondary site involvement, silentBack pain, started in SRI 6/52 laterBack pain, started in SRI 6/52 laterDiscitis, psoas abscess, ? aortitisDiscitis, psoas abscess, ? aortitisLoculated pulmonary empyemaLoculated pulmonary empyema

Case 3, MRICase 3, MRI

Case 3, CT ChestCase 3, CT Chest

Situation in Forth Valley and Situation in Forth Valley and ElsewhereElsewhere

Considerable morbidity and mortality Considerable morbidity and mortality associated with Cannula site associated with Cannula site infectioninfection

Patient dies from Patient dies from infection of aninfection of an intravascular intravascular device, how dodevice, how do you defend yourself?you defend yourself?

IV Cannula, Whose Responsibility Is It?IV Cannula, Whose Responsibility Is It?

EVERYBODY’SEVERYBODY’S

Prevention of Cannula Prevention of Cannula Site InfectionSite Infection

Prevention of Cannula Site Prevention of Cannula Site InfectionInfection

Does the patient need IV access for Does the patient need IV access for TREATMENT?TREATMENT?

If the answer is YES, proceed to the If the answer is YES, proceed to the PVC insertion bundlePVC insertion bundle

Remember “bleeding the patient” Remember “bleeding the patient” does not qualify as “need” for does not qualify as “need” for insertion of an IV cannulainsertion of an IV cannula

PVC Insertion BundlePVC Insertion Bundle A PVC is clinically indicatedA PVC is clinically indicated Hand hygiene is carried outHand hygiene is carried out Skin is decontaminatedSkin is decontaminated Aseptic (no touch) techniqueAseptic (no touch) technique Sterile dressing including date and Sterile dressing including date and

time labeltime label

Does the Patient Need IV AccessDoes the Patient Need IV Access PVC Insertion Bundle and Removal Record Is PVC clinically indicated for this patient YES, WHY: IV Fluids/Blood TransfusionIV Drugs Diagnostics Chest Pain Please tick Is patients skin decontaminated and allowed to dry Is patients skin decontaminated and allowed to dry YES / NO Hand hygiene carried out prior to insertion Hand hygiene carried out prior to insertion YES / NO Aseptic Non Touch Technique is used to insert PVC Aseptic Non Touch Technique is used to insert PVC YES / NO If not possible, use eitherIf not possible, use either STERILE GLOVES or or MINI CHLORAPREP Sterile dressing applied after insertion Sterile dressing applied after insertion YES / NO Patients Name:__________________________ Ward: _______________ Inserted by: _______________________ Date & Time:________________ Size/Colour:______________________ Batch No:___________________ Insertion Site: __________________ _____________________ Removed by: ______________ Date & Time: _____________

Skin DecontaminationSkin Decontamination ChloraPrepChloraPrep

Adhesive DressingAdhesive Dressing With date and time labelWith date and time label

Follow UpFollow Up Regular monitoring of the site by the Regular monitoring of the site by the

staff on the wardstaff on the ward Documentation in patient’s notesDocumentation in patient’s notes When to replace the cannula, 72 hrsWhen to replace the cannula, 72 hrs When to remove the cannula, clinical When to remove the cannula, clinical

needneed When is a cannula site infectedWhen is a cannula site infected

What to Watch for?What to Watch for? Sometimes the first clue is pain at Sometimes the first clue is pain at

the site of insertionthe site of insertion

Infected Cannula SiteInfected Cannula Site Documentation alone will not cure itDocumentation alone will not cure it Swab the site for culture and Swab the site for culture and

sensitivitysensitivity Assess the clinical pictureAssess the clinical picture Commence appropriate antibiotic Commence appropriate antibiotic

treatmenttreatment– choice of antibioticchoice of antibiotic– choice of mode of administrationchoice of mode of administration

Do Do NOTNOT Think of Treating Local Infection Think of Treating Local Infection with Local Antibiotic Ointment with Local Antibiotic Ointment

Developments in Forth ValleyDevelopments in Forth Valley Front door services, need for IV Front door services, need for IV

accessaccess Documentation, stickers in notesDocumentation, stickers in notes PVC care bundle implementationPVC care bundle implementation Change of skin cleansing solutionChange of skin cleansing solution ? Change of IV cannula brand? Change of IV cannula brand

? The Future in Forth Valley? The Future in Forth Valley BD Venflon with safety deviceBD Venflon with safety device

New Products, any good?New Products, any good? FastBandFastBand

Any Questions?Any Questions?